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Randomized Controlled Trial
. 2019 Dec 30;20(1):797.
doi: 10.1186/s13063-019-3943-x.

Using an incentive spirometer reduces pulmonary complications in patients with traumatic rib fractures: a randomized controlled trial

Shao-Kai Sum  1 , Ya-Chuan Peng  2 , Shun-Ying Yin  1 , Pin-Fu Huang  1 , Yao-Chang Wang  1 , Tzu-Ping Chen  1 , Heng-Hsin Tung  3 , Chi-Hsiao Yeh  4   5
Affiliations
Randomized Controlled Trial

Using an incentive spirometer reduces pulmonary complications in patients with traumatic rib fractures: a randomized controlled trial

Shao-Kai Sum et al. Trials. .

Abstract

Background: An incentive spirometer (IS) is a mechanical device that promotes lung expansion. It is commonly used to prevent postoperative lung atelectasis and decrease pulmonary complications after cardiac, lung, or abdominal surgery. This study explored its effect on lung function and pulmonary complication rates in patients with rib fractures.

Methods: Between June 2014 and May 2017, 50 adult patients with traumatic rib fractures were prospectively investigated. Patients who were unconscious, had a history of chronic obstructive pulmonary disease or asthma, or an Injury Severity Score (ISS) ≥ 16 were excluded. Patients were randomly divided into a study group (n = 24), who underwent IS therapy, and a control group (n = 26). All patients received the same analgesic protocol. Chest X-rays and pulmonary function tests (PFTs) were performed on the 5th and 7th days after trauma.

Results: The groups were considered demographically homogeneous. The mean age was 55.2 years and 68% were male. Mean pretreatment ISSs and mean number of ribs fractured were not significantly different (8.23 vs. 8.08 and 4 vs. 4, respectively). Of 50 patients, 28 (56%) developed pulmonary complications, which were more prevalent in the control group (80.7% vs. 29.2%; p = 0.001). Altogether, 25 patients had delayed hemothorax, which was more prevalent in the control group (69.2% vs. 29.2%; p = 0.005). Two patients in the control group developed atelectasis, one patient developed pneumothorax, and five patients required thoracostomy. PFT results showed decreased forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) in the control group. Comparing pre- and posttreatment FVC and FEV1, the study group had significantly greater improvements (p < 0.001).

Conclusions: In conclusion, the use of an IS reduced pulmonary complications and improved PFT results in patients with rib fractures. The IS is a cost-effective device for patients with rib fractures and its use has clinical benefits without harmful effects.

Trial registration: ClinicalTrials.gov, NCT04006587. Registered on 3 July 2019.

Keywords: Forced expiratory volume; Forced vital capacity; Incentive spirometer; Pulmonary complications; Rib fracture.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Study flow chart. COPD chronic obstructive pulmonary disease, CXR chest X-ray, ISS Injury Severity Score, y/o years old
See this image and copyright information in PMC

References

    1. Karadayi S, Nadir A, Sahin E, Celik B, Arslan S, Kaptanoglu M. An analysis of 214 cases of rib fractures. Clinics (Sao Paulo) 2011;66:449–451. doi: 10.1590/S1807-59322011000300015. - DOI - PMC - PubMed
    1. Stitzel JD, Kilgo PD, Weaver AA, Martin RS, Loftis KL, Meredith JW. Age thresholds for increased mortality of predominant crash induced thoracic injuries. Ann Adv Automot Med. 2010;54:41–50. - PMC - PubMed
    1. Brown SD, Walters MR. Patients with rib fractures: use of incentive spirometry volumes to guide care. J Trauma Nurs. 2012;19:89–91. doi: 10.1097/JTN.0b013e31825629ee. - DOI - PubMed
    1. Baker SP, O’Neill B, Haddon W, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14:187–196. doi: 10.1097/00005373-197403000-00001. - DOI - PubMed
    1. Garcia VF, Gotschall CS, Eichelberger MR, Bowman LM. Rib fractures in children: a marker of severe trauma. J Trauma. 1990;30:695–700. doi: 10.1097/00005373-199006000-00007. - DOI - PubMed

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